Studying The Kiwis: Could Britain's Junior Doctors Learn From New Zealand?

As the British Medical Association (BMA) prepares for another meeting to discuss further industrial action against the government's proposed junior doctor contract, the New Zealand Resident Doctor's Association (NZRDA) has also announced a campaign for a better contract for junior doctors, with the threat of strikes on the horizon. Can British Doctors and their union learn from New Zealand?

Following a year-long stalemate punctuated by brief periods of attrition, Britain's junior doctors remain locked in a dispute with the government over a proposed new contract, warning of "escalated" industrial action should the Government refuse to address concerns over patient safety and fairness. This is likely to encompass a rolling programme of strikes, starting in September. The BMA Junior Doctors Committee claim that worries have been repeatedly raised and not addressed, including concerns about weekend working and pay for those working less than full time.

JDC chair Ellen McCourt has said:

"Forcing a contract on junior doctors in which they don't have confidence, that they don't feel is good for their patients or themselves, is not something they can accept".

Echoing events in Britain, New Zealand's Resident Doctors Association (NZRDA) called for changes to junior doctor working patterns, including the number of potential consecutive 10-hour night shifts to be reduced from seven to four, and the number of consecutive day shifts to be reduced from 12 to 10.

The campaign is focusing entirely on patient safety and has centred on a strong social media presence with clear statements and images:

Highly publicized figures from NZRDA's survey of its 3600 members reported that 300 doctors had fallen asleep behind the wheel on the way back from work, and more than 1000 doctors had made a mistake which affected patient care due to exhaustion. The NZRDA has warned that if there are no changes to rosters, there will be industrial action for the third time after previous strikes in 1992 and 2006.

The NZRDA was originally founded in 1985. In contrast to Britain's BMA it represents only Junior Doctors, not all doctors. British doctors moving to New Zealand are often surprised about the power and proactive nature of the organisation. The face of the NZRDA for the last few decades has been the organisation's National Secretary Dr Deborah Powell. She is perceived by doctors, media and public alike as a fiery and uncompromising battleaxe who persistently wields clout in negotiations.

These negotiations have yielded a number of benefits over time for junior doctors in New Zealand, which have included: consistent increases in pay, final year medical students being given a salary, free canteen food during working hours, training and membership costs being covered, presence of cross-cover and relief doctors to cover short-term absences, ease in going out-of-training for family or travel. There is even a motivation for hospitals and clinics to ensure that their junior doctors claim all of their annual and study leave, as the amount not used becomes "cashed out" as a payment.

In the few instances when conditions have deteriorated, the NZRDA has been aggressive. In April 2008, they gave notice of a nationwide 48-hour strike over pay, conditions and ongoing issues of retention, as 40% of Kiwi doctors were moving to Australia. At the time, a first year house-surgeon in NZ earned 88,000 NZD (£40,000) on average. Junior doctors sought a 10% pay rise over three consecutive years (twice that of other health service workers) rather than two rises of 4% over two years.

The strikes were widely seen as a success which brought the desired outcome for the doctors, caused no harm to patients (indeed, emergency department waiting times were markedly reduced), has improved retention of doctors and made New Zealand a very attractive destination for British and other doctors. They have also underlined the power of the NZRDA to fight annually for better conditions.

The success of these victories is reflected by a reversal in the exodus of Kiwi doctors to the United Kingdom, such that British doctors are now flocking to New Zealand at record levels. We can only speculate whether a single-minded force such as Deborah Powell may have challenged the various events which have taken place over the last decade and reduced morale of British junior doctors to such an extent: Loss of House Officer Accommodation, shortages of training posts, the ill-received Medical Training Application System (MTAS), pay increases below inflation, consistently increasing GMC and examination fees.

How would the NZRDA manage if metaphorically transplanted onto the negotiating table closer to home? Their use of punchy statements and images, peppered with some humour, has helped the public clearly identify the junior doctors' argument. Based on their track record, would they have hesitated to legally challenge the UK government: particularly on Jeremy Hunt's early assertion that we do not already have a seven-day emergency NHS, a proclamation which has already led to well-documented patient harm?